School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

Abstract

Hypertension, a major modifiable risk factor for cardiovascular disease, is increasing among adolescents. While socioeconomic factors contribute to hypertension risk in adults, similar data in children is lacking. We examined the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents. School neighborhood socioeconomic status (SES) was assessed via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation. Using data from a school BP surveillance program implemented in the Houston metropolitan area, we performed a cross-sectional analysis using both univariate and multivariable regression analyses. Among 21,392 students aged 10 to 19 years during the 2000 through 2017 academic years, the prevalence of sustained hypertension was 2.6%. Although 85% of students attended schools located in neighborhoods in quartiles 1 (Q1) and 2 (Q2) (higher ADI represents more deprivation), Hispanics and African Americans were overrepresented in the schools located inside more deprived neighborhoods. The highest sustained hypertension rate (4.6%) was observed among students attending Q 3 and Q4 schools compared to 2.3% in Q 1 and Q2 schools (p < 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension. Attending school in neighborhoods with lower SES may account for the increased hypertension prevalence in minority adolescents. Characteristics of school neighborhoods play an important role in disparities observed in hypertension prevalence, providing direct opportunities to encourage improved dietary intake and physical activity, both of which are important determinants of hypertension.